NEW YORK (Reuters Health) - The "obesity paradox" -- an
unexpected decrease in illness and death with increasing body
weight or BMI, which has been described in people with heart
failure and in patients having angioplasty -- exists in people
with high blood pressure and diseased heart arteries as well,
new study findings show.

In the study, researchers found that overweight and obese
adults with high blood pressure and coronary artery disease had
a lower risk of heart attack, stroke or death, compared with
their normal-weight counterparts.

The reasons for the apparent protective effect of increased
BMI in these populations "are unclear," note Dr. Seth Uretsky
from St. Luke's-Roosevelt Hospital in New York City and
colleagues in the American Journal of Medicine.

They investigated the effect of overweight and obesity on
heart-related outcomes in 22,576 people with treated high blood
pressure and coronary artery disease who participated in a
large study.

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Compared to normal-weight subjects with a BMI between 20
and 25, the risk of death, heart attack, or stroke was lower in
subjects who were overweight (BMI 25 to 30), and in those with
class I obesity (BMI 30 to 35) and class II-III obesity (BMI 35
or greater).

"This 'obesity paradox' occurred in men and women across
all age groups, even though blood pressure was better
controlled in normal-weight patients," the investigators note.

In a commentary, Dr. Carl J. Lavie and colleagues of the
Ochsner Medical Center, New Orleans caution that while improved
outcomes appear to be consistently associated with increased
BMI, "one should not conclude that weight reduction is
detrimental in overweight populations."

Results of numerous studies, they point out, clearly
support the benefits of "purposeful weight reduction" in obese
patients with heart disease, despite the obesity paradox.

"As we continue to investigate the obesity paradox in
cardiovascular disease ... we should remember the old proverb,
"Only one thing is certain - that is nothing is certain," Lavie
and colleagues advise.